Section 179 in 2014

Update on the 2014 Section 179 Tax Deduction

You still have thirty days to make the most of $25K

Section 179 of the IRS tax code has gotten a lot of heat for its diminished deduction limit in 2014. Compared to last year’s deduction limit of $500,000 for equipment purchases, the 2014 limit has been reduced to $25,000. Despite the ADA’s efforts in urging Congress to extend the Section 179 tax provision to 2013 levels, there hasn’t been any word on whether an extension will be granted.

The silver lining: although $25,000 isn’t as desirable as $500,000, Section 179 provides some real relief to dental practice owners purchasing small equipment in 2014. Section 179 can change each year without notice, so it’s beneficial to take advantage of any deduction while it’s still available.

Up to $25,000 in dental equipment can be written off in 2014

ELIGIBILITY AND QUALIFICATIONS

Most tangible goods qualify for the Section 179 Deduction. For basic guidelines on what equipment is covered under the Section 179 tax code, refer to this list of qualifying equipment. Note: To qualify for the Section 179 Deduction, the equipment and/or software purchased or financed must be placed into service between January 1, 2014 and December 31, 2014.

All new and used equipment is eligible for deduction up to $25,000 for 2014. All companies that lease, finance or purchase equipment with a total value of less than $200,000 still qualify for the Section 179 deduction. Expenses over that maximum amount begin to decrease on a dollar-for-dollar deduction scale, effectively gearing this tax code toward small and medium-sized businesses.

DEPRECIATION DEDUCTION BENEFITS

While Section 179 doesn’t increase the total amount you can deduct in a single year, it allows you to benefit from the deduction all at once. In other words, rather than having to deduct an asset’s value over the course of several years, Section 179 allows businesses to get the entire depreciation deduction in a single year, a practice known as first-year expensing.

According to regular depreciation rules, if you were to purchase new high-speed handpieces for each of your operatories, you’d be obligated to deduct a portion of each handpiece’s cost over multiple years. For the next five years, you’d only be able to deduct a fraction of the overall expense. With the Section 179 tax code, though, you are allowed to immediately deduct the entire expense of the handpieces in a single year instead of having to track their depreciation over time.

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Check out an example of Section 179 at work:

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 SOURCE: Section179.org

EPA Rule on Amalgam Separators

EPA Proposes Amalgam Separator Rule

Nationwide rule requires amalgam separators in every office

In an effort to reduce the discharge of dental amalgam into the environment, the U.S. Environmental Protection Agency (EPA) recently proposed a rule under the Clean Water Act requiring dentists to install amalgam separators.

Studies show that half of the mercury that enters publicly owned treatment works originates from dental amalgam. Tiny particles of amalgam can bypass chairside traps every time an amalgam filling is placed or removed. After water treatment, mercury is distributed back in the form of precipitation and consumed by fish, making its way into our food chain.  

The proposed rule would require all affected dentists to control mercury discharges to publicly owned treatment works. Specifically, it would require them to cut their dental amalgam discharges to a level achievable through the use of amalgam separators and the use of other best management practices. The EPA expects compliance with this proposed rule would cut metal discharge to treatment works, half of it from mercury, by at least 8.8 tons a year.

“The rule would strengthen human health protection by requiring removals based on the use of a technology and practices that approximately 40% of dentists across the country already employ”
– Kenneth Kopocis, Deputy Assistant Administrator for the EPA’s Office of Water

The rule would allow dentists to show they are in compliance by installing, operating, and maintaining an amalgam separator. However, if the existing separators in a dental practice do not remove the percentage of amalgam in the proposed requirements, a practice can still be ruled as compliant for the life of the existing separator. Finally, it would limit dental dischargers’ reporting requirements to annual certification and record-keeping instead of wastewater monitoring.

The EPA will accept public comments on the proposal for 60 days following publication in the Federal Register. A public hearing also is scheduled for November 10. The agency expects to finalize the rule in September 2015.

Ebola Virus and Dentistry

The Ebola Epidemic: A Concern for Dentistry?

The recent Ebola epidemic has the entire world on high alert. Although the majority of the 8,400 reported cases have been contained to West Africa, the Ebola virus has already made its way into the United States. Following the death of Thomas Eric Duncan (the first travel-related Ebola case in the U.S.), the CDC confirmed Sunday that a nurse who treated Duncan at a Texas hospital has contracted Ebola. Authorities presume that the infection may be a result of a “breach” of infection control protocol.

Since healthcare workers who come in contact with infected patients have the highest risk of contracting Ebola, now is the time to emphasize the importance of proper infection control procedures with your team.

Precautionary Checklist

To keep your staff and patients safe, consider the following precautions:

  • Monitor the Ebola situation online. Utilize the resources available on the CDC website.
  • Assess and ensure availability of appropriate personal protective equipment (PPE) and hand hygiene supplies.
  • Review facility infection control policies.
  • Review environmental cleaning procedures.
  • Be on the lookout for patients with fever or symptoms of Ebola who have traveled from Liberia, Guinea or Sierra Leone in the past 21 days.
  • Recognize a case of Ebola and be prepared to use appropriate infection control measures.
  • Begin education and refresher training for healthcare providers on Ebola virus disease signs and symptoms, diagnosis, triage procedures, employee sick leave policies, how and to whom Ebola cases should be reported and procedures to take following unprotected exposures.
  • Avoid contact with the blood or bodily fluids of an infected patient.
  • Ensure laboratories review procedures for appropriate specimen collection, transport and testing of specimens from patients who may be infected with Ebola virus.

Other Facts About the Ebola Virus

According to the CDC, a person infected with Ebola is not contagious until symptoms appear. Signs and symptoms of Ebola include fever (greater than 101.5°F) and severe headache, muscle pain, vomiting, diarrhea, stomach pain or unexplained bleeding or bruising. Symptoms can appear from 2 to 21 days after exposure. After 21 days, if an exposed person does not develop symptoms, they will not become sick with Ebola.

The Ebola virus is spread through direct contact (through broken skin or mucous membranes) with blood and bodily fluids (e.g., urine, feces, saliva, vomit and semen) of a person who is sick with Ebola, or with objects (e.g., needles) that have been contaminated with the virus. Ebola is NOT spread through the air or by water or, in general, by food.

Sharpen Tools for Swifter Turnover


Sharper Tools Mean Greater Efficiency

Instruments are essential to any dental procedure, and the sharper they are, the better. Proper sharpening techniques not only make for longer-lasting instruments, they enable quicker patient turnover due to more efficient hygiene procedures. Do your practices measure up?

Sharpening

For your 6-month prophylaxis appointments, it’s recommended you sharpen your instruments at least once a week. For your scaling and root planing procedures, sharpen your instruments before each procedure. Manual stones are easier because they are portable and can be used anywhere in the office. Automatic sharpeners require a power source, which limits when and where you can use them.

Purchasing Frequency

The average office should order new instruments at least once a year. A good rule of thumb is to have enough procedure setups for a half-day’s patients. This number can be determined by averaging the number of procedures per day over several weeks. If your practice doesn’t have a good supply of instruments, invest in more setups to improve your efficiency.

Instrument Knowledge

The most unbiased and universal way to check if an instrument is sharp would be to use a test stick. Each hygienist uses different pressures when scaling teeth; thus, basing instrument sharpness on pressure applied isn’t an objective test.

DID YOU KNOW?

PureLife carries every instrument needed for your hygiene procedures. The Montana Jack scaler and Wingrove Titanium Implant Instruments are unique additions to any dental office. The ultra-light Montana Jack is a hybrid universal scaler that can be used for the entire mouth. The Wingrove Titanium Implant Instruments boast solid medical-grade titanium that won’t scratch implants.

Handling Pediatric Patients


Pediatric Patients

Even super-heroes should be handled with kid gloves

By now, you may have heard about the potential impacts of the Affordable Care Act (ACA) on dentistry. One interesting likelihood: an influx of pediatric patients, as the ACA provides for dental coverage for children under 19. According to the American Dental Association (ADA), approximately 8.7 million children could gain extensive dental coverage by 2018. This means that more general dentists will have the opportunity to see younger patients. However, there are several things to consider when treating this population.

Chemical Sensitivities

Children aren’t just little adults. Their bodies are still developing, so chemicals that might not have much of an impact on an adult can have a larger impact on a child. A case in point: BPA.

Bisphenol A (BPA), a chemical compound found in everyday plastic products, can also be found in many dental composites and sealants. Unfortunately, BPA acts as an endocrine disrupter, and studies have linked it to a plethora of health maladies in children, including heart and kidney disease, emotional behavioral problems, and even an increased risk of obesity in teenaged girls.

In addition to these generalized health issues, BPA has also become a dental concern: research from France has suggested that BPA exposure in children can adversely affect cells that produce tooth enamel, making it fragile or brittle. This Molar Incisor Hypomineralisation (MIH), which occurs selectively in permanent incisors and first molars, affects about 18% of children between the ages of 6 and 8. Children with MIH are highly prone to dental caries and are very susceptible to tooth sensitivity and pain. Importantly, the age at which children develop their first molars and permanent incisors is the age at which studies show that humans are most sensitive to BPA.

The Asthma Link

Most recently, asthma – one of the most common childhood diseases – has been linked to BPA exposure, according to a recent study at the Columbia Center for Children’s Environment Health at the Mailman School of Public Health (Donohue, 2013). This is important to dental healthcare professionals because another study has linked asthma to an increased risk of dental caries (Alkali, 2013). Asthma medications were shown to reduce the salivary flow rate and buffering capacity in the mouth, leading to a potential for increased caries and gingivitis. Asthmatic children also had higher levels of Strep mutans and Lactobacillus bacteria, compared to healthy children.

Alternatives for Improved Health

Since dental caries is the most prevalent disease in children, it’s important to be on the lookout for increased caries risk factors, like asthma. Fortunately, dental healthcare providers have a number of tools available to help reduce the prevalence of caries in their pediatric patients, without exposing them to additional doses of BPA.

For example, for patients with increased caries risk factors, dentists might want to consider a chlorhexidine varnish. A relatively new product, chlorhexidine varnish addresses the undesirable side effects of chlorhexidine rinses and gels, while still reducing the presence of Strep mutans (Sijjan, 2013).

BPA-free versions of many products are also available. The Venus Pearl and Venus Diamond lines of composites from Heraeus Kulzer are not only BPA-free, but highly durable and well-suited for both anterior and posterior restorations.

Manufacturer Pulpdent produces the BPA-free ACTIVA and Embrace product lines, the majority of which are especially well-suited for pediatric patients as they are hydrophilic (i.e., they work well in a moist environment). These products include the innovative ACTIVA BioACTIVE Restorative and ACTIVA BioACTIVE Base/Liner, as well as the Embrace Wetbond Pit & Fissure Sealant and Embrace Wetbond Resin Cement.

The Triclosan Controversy


What’s the Trouble with Triclosan?

Antibacterial agent comes under fire for potential health risks

Colgate Total has been in the news lately, thanks to one of its active ingredients – triclosan. The antibacterial chemical has come under increased scrutiny as new studies have raised questions about its safety. These studies show that triclosan may be influencing cancer cell growth and disrupting the way hormones work in animals.1 Whether these undesirable side effects are present in humans is harder to determine, but it doesn’t bode well for the chemical.

So why include a questionable chemical? Total’s patented formula has proved effective in reducing the bacteria that cause plaque and gingivitis, which can lead to periodontal disease.

However, triclosan’s use in other products hasn’t been proven to be beneficial. Triclosan can be found in many different types of products – everything from cosmetics to clothing to rugs. Its presence in some of the products that dental healthcare professionals use every day for infection control purposes might be cause for concern.

For example, triclosan is a common ingredient in antibacterial hand soaps, even though it has not been proven to be more effective at reducing illness than washing hands properly with regular soap and water. It’s this fact that has the FDA re-examining the safety and efficacy of including triclosan in soap and body washes, outside of hospital settings.

According to FDA microbiologist Colleen Rogers, Ph.D., “New data suggest that the risks associated with long-term, daily use of antibacterial soaps may outweigh the benefits.” In addition to the cancer and hormonal effects, triclosan is also suspected of contributing to bacterial resistance of antibiotics – a problem with broad-reaching implications.

Fortunately, it’s easy to move away from hand soaps containing triclosan, while taking the opportunity to emphasize the importance of following a proper hand-washing protocol with your team. Hand sanitizers, which also might contain triclosan, are available in triclosan-free versions with alcohol as the active ingredient – look for at least 60% alcohol make sure to use enough to wet hands for at least 15 seconds.

1 Tiffany Kari, Colgate Total Ingredient Linked to Hormones, Cancer Spotlights FDA Process, (http://www.bloomberg.com/news), August 11, 2014

X-Ray Radiation Protection


Radiation Protection

Easy ways to avoid harmful x-ray exposure

Dental x-rays are critical to evaluating and diagnosing many oral diseases and conditions. Although radiation exposure from x-rays is low, the effects can accumulate from multiple sources over time. Limiting radiation exposure can be achieved through these simple techniques:

PROTECTING THE PATIENT

Obtaining and reviewing previous full-mouth series or panoramic x-rays can eliminate the need to take new radiographs. For example, patients with stable periodontal health and a low caries rate may be able to increase the time between bitewings from annually to every 18 to 24 months years (ADA, 2012). If new radiographs are necessary, radiation exposure can be decreased through the use of higher film speeds, shielding, and collimation.

HIGHER FILM SPEEDS: Using the fastest film available significantly reduces radiation exposure. Currently, intraoral X-ray film is available in three speeds: D, E, and F. E-speed film is almost twice as fast as D-speed film—and about 50 times faster than traditional x-ray film. F-speed film requires about 25% less exposure than E-speed film and 60% less exposure than D-speed film. Multiple studies have confirmed that F-speed film has the same useful density range, latitude, contrast, and image quality as D- and E-speed films, and it can be used in routine intraoral radiographic examination without sacrificing diagnostic information (ADA, 2012).

SHIELDING: The use of aprons and thyroid collars shields the gonads and thyroid gland from radiation exposure, which is particularly important among vulnerable populations, such as children and pregnant women. The ADA recommends that every patient should be covered with an apron. When taking routine bitewing and periapical radiographs, a thyroid collar should be used. Panoramic imaging is an exception to the rule; a thyroid collar can obscure large areas of the target zone (ADA, 2012).

COLLIMATION: A collimator is a metallic barrier with an opening in the middle that is used to reduce the size of the x-ray beam, and, thus, the exposure area. Dental x-ray beams are usually collimated to a circle 2¾” in diameter. When an x-ray beam is directed at a patient, the hard and soft tissue absorbs about 90% of the photons, while approximately 10% passes through the patient and reaches the film (ADA, 2012).

PROTECTING THE OPERATOR

Although dental professionals receive less exposure to ionizing radiation than do other occupationally-exposed healthcare workers, operator protection measures are essential to minimize exposure. Protective measures include the use of barrier shielding, occupational radiation exposure limits, and personal dosimeters.

SHIELDING: When possible, operators of radiographic equipment should use barrier protection, and barriers should ideally contain a leaded glass window to enable the operator to view the patient during exposure. When shielding is not possible, the operator should stand at least two meters from the tube head and out of the path of the primary beam.


EXPOSURE LIMITS & PERSONAL DOSMITERS:
The maximum permissible annual dose of ionizing radiation for health care workers is 50 millisieverts (mSv) and the maximum permissible lifetime dose is 10 mSv multiplied by a person’s age in years. Personal dosimeters must be used by workers who may receive an annual dose greater than 1 mSv to monitor their exposure levels. Pregnant dental personnel operating x-ray equipment must also use personal dosimeters, regardless of anticipated exposure levels (ADA, 2012).

PureLife now offers personal dosimeters that measure the amount of high energy ionizing radiation a person has been exposed to. The PureLife Radiation Detection Badge is a small, reliable badge designed for superior accuracy, easy handling and cleanliness.

Waste Compliance Made Easy


Keeping Up with Waste Compliance

It’s as easy as 1-2-3…

Keeping up with waste compliance can be confusing and expensive. With dental offices subject to numerous regulations at the federal, state, and local level, knowing which compliance protocols are applicable to your practice isn’t easy. Not to mention, waste is a broad category comprised of a variety of issues that lack actionable solutions. Thankfully, compliance is easier to achieve than it seems. Here’s a breakdown of key waste compliance issues in terms of their (a) problems, (b) regulations, and (c) solutions:

1. Bio-Hazard and Sharps Waste

THE PROBLEM: Many dental practices opt for a waste disposal pickup service that is unknowledgeable of dental regulations. As a result, dentists may be locked into confusing contracts without a point of contact that understands their compliance needs–leaving dental professionals responsible for understanding their requirements or risk non-compliance.

THE REGULATIONS: Specifics concerning bio-hazard and sharps regulations vary by state, with each state requiring one of these disposal practices:

  • Both sharps and soft waste are to be disposed of after a designated time limit
  • Both sharps and soft waste are to be disposed of once the container is full
  • Only sharps are to be disposed of once the container is full and soft waste is to be disposed of after designated time limit

THE SOLUTION: Mail-back systems are a convenient and cost-effective alternative to pickup services. Ranging from 1-quart to 30-gallon containers, these mail-back systems eliminate the use of costly pickup services and include a prepaid return shipping box that allows for complete tracking and documentation. When ready, simply place your container in the prepaid return box and leave it to be picked up along with the rest of your packages.

2. Mercury Waste

THE PROBLEM: Much of the mercury that enters our wastewaters originates from dental amalgam. Tiny particles of amalgam can bypass chairside traps every time an amalgam filling is placed or removed. After water treatment, mercury is distributed back in the form of precipitation and consumed by fish, making its way into our food chain.

THE REGULATIONS: At least 12 states and numerous localities have mandatory mercury pretreatment programs in place. At the federal level, the EPA recently announced that it would be formulating a nationwide rule regulating disposal methods for dental amalgam. This rule is expected to be finalized in the near future.

THE SOLUTION: It is possible to eliminate mercury pollution by installing an amalgam separator. Installation is extremely simple and allows dentists to eliminate 99% of their mercury waste, and maintenance usually involves replacing the canister once it’s full, generally every 6-12 months.

3. X-Ray Waste

THE PROBLEM: Dental offices generate many different forms of waste as a result of traditional x-ray processing that can have a serious impact on wastewaters and soil.

THE REGULATIONS: The disposal of used fixer is strictly regulated nationwide due to its high toxicity level. However, many regulations can vary significantly by location. To determine your waste disposal requirements, contact your local OSHA office, wastewater treatment agency, or state dental association.

THE SOLUTION: X-ray waste can be prevented from entering the environment by implementing an x-ray waste collection and recycling program. This includes capturing lead waste in an approved UN/DOT storage container, filtering used fixer via a photo chemical filter to remove silver content, and recycling x-ray film. The optimal solution is to shift to a digital x-ray system.

 


Achieve complete waste compliance with PureLife Waste Solutions! Save up to 50% on your waste compliance products and services– no contracts required! Call 877-777-3303 ext 4 to talk to a Waste Management Specialist and request a FREE no-obligation quote.

 

Tips for Chairside Whitening


More Than Cleaning

Incorporate elective services into routine visits

Standardizing and organizing examination protocols creates a framework for recare and restorative visits. Here is an “old school” way to integrate whitening acceptance into your daily routine. The two key pieces of equipment for this tip are: a hand mirror and a shade guide.

Shade GuideOne way to increase whitening business is for assistants and hygienists to make a habit of doing a “color analysis” for each patient. With the patient looking into a mirror, simply say to them, “We know that teeth can change color over time. What I’d like to do now is to determine the current color of your teeth. I’ll need your help with this part.” This immediately gets the patient involved in their care and gives you an opportunity to talk whitening options.

Each operatory (hygiene too) should be equipped with shade guides. Set it up from lightest to darkest; make sure the shade guide also includes newer ‘bleaching’ colors. Hold the shade guide so that your patient can see the colors.

Next, have the patient guide the selection of the shade–this gives them an idea of what their teeth could look like. If your patient has an interest in whitening, he/she will normally take up the issue with you and you will have permission to ask other questions. These might include: “Other than the color shifts, is there anything else that you notice about your smile?”

Thanks to mainstream media, talk shows and magazines, patients are more knowledgeable about tooth discoloration, malodor and the importance of a healthy mouth to overall health. Incorporating something as basic as a shade guide review (at least yearly) is a powerful way to make regular inquiries into all of your aesthetic services.

Tips and Pointers in Selecting Shades

  • For most accurate results, the colors in the room should be neutral as well as the patient’s clothes. Drape the patient with a neutral gray bib or towel when taking a shade. It neutralizes the eyes’ color perception.
  • Female patients: If applicable, remove lipstick.
  • Make sure teeth are not dehydrated.
  • The mouth of the patient should be at eye level.
  • Determine the amber or gray color type of the patient.
  • Determine the base shade of the patient and remove matching shade group (Chromascope).
  • Determine the shade intensity within the shade group.
  • Compare the selected shade once again with the natural tooth.
  • Color Map: Note range of shade, striations, and color banding or mottling. Close examination will reveal a blending of various colors.
  • Collaborative Whitening: All team members can perform color assessments.

In sum, incorporating simple, “old school” basics into your protocols will help your patients understand the full menu of services offered by your practice and can help drive elective procedures such as whitening